| NPI | 1003314329 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: OK 244) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: OK 7866) | |
| Enumeration Date | 2018-02-01 |
| Last Update Date | 2024-07-23 |